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absite infxn
| Question | Answer |
|---|---|
| what pathogens are in stomach? How many? | virtually sterile, some GPC and yeast |
| what pathogens are in sm bowel? How many? | 10^5, mostly GPCs |
| what pathogens are in distal sm bowel? How many? | 10^7, GPCs, GPR, GPCs |
| what pathogens are in colon? How many? | 10^11, almost all anaerobes, some GNRs, GPCs |
| MC anaerobe GI | Bacteroides fragilis |
| MC aerobe in GI | e coli |
| MC GN sepsis | E coli |
| name toxins in E coli sepsis | Endotoxin lipopolysacc lipid A released, triggers TNF from macrophages->complement and coag cascade |
| what happens to blood glucose before/during sepsis | incrsd, at first due to impaired utilization, then due to insulin resistance |
| when do abscesses appear | 7-10 d s/p surgery |
| types of bac in abscesses | all have anaerobe, 80% have aerobes |
| tx abscess | drainage, but add Abx if DM, cellulitis, bioprosthetic implants, s/s sepsis, F, WBC |
| rate of wound infxn clean surgery, ex | hernia, 2% |
| rate of wound infxn clean contaminated, ex | elective colon resxn w prep, 5% |
| rate of wound infxn contaminated surgery, ex | gun shot bowel, 5-10% |
| rate of wound infxn grossly contaminated surgery, ex | abscess, 30% |
| MC organism in surgical wound | S aureus |
| MC GNR in surgical wound infxn | E Coli |
| MC non surgical infxn s/p surgery | UTI |
| 3 MC organism line infxn | Staph Epi, #2 S aureus, #3 yeast |
| how many CFU mean line infxn | 15 |
| when can necrotizing fascitis appear | within hrs s/p surgery |
| MC causes nec fascitis | Grp A strep (Strep Pyo), C perfringens |
| what 3 grps at risk for nec fasc | DM, immunocomp, poor blood supply |
| what lab work see in nec fascitis | WBC>20, hypoNa |
| key findings physical exam nec fascitis | thin gray drainage, edema, skin blistering/sloughing, crepitus/soft tissue gas, |
| tx nec fascitis | debridement and PCN |
| what's fournier's gangrene, what pts get it, and what organisms | perineal and scrotal area in DM and immunocompromised. Mixed organisms |
| is nocardia a fungus? Tx? | no, bactrim |
| where is histo found? Cocci? Tx? | histo in Mississippi and Ohio river valleys, tx both amph for severe infxn |
| tx candida | flucanazole, amph for severe |
| where does cryptococc infect? Tx? | neuro (meningitis), amph for severe [remember cryptospor is parasite causing diarrhea] |
| diagnosis for SBP | 500PMN/cc (another place says 250); note cx often negative |
| if monobac what SBP 2 org MC? | E Coli, Strep |
| tx SBP | ceftriax |
| ppx SBP | fluoroquin |
| if SBP not improving on Abx, then | think intrabd source, ie perf diverticular abscess |
| what's 2ry SBP, organisms | intrabd source (transmucosal migration, perf as opposed to decrsd host defense); polymicrob (B Fragilis, E Coli, Enterococc) |
| risk HIV transmission if + blood transfusion? + mother? Needle stick? | 70%, 30%, 0.3% |
| what give for HIV exposure and when | AZT, lamivudine 1-2 hrs |
| seroconversion in HIV | 6-12wks |
| MC cause GI complaints HIV | CMV colitis |
| where does lymphoma appear in HIV, MC type and tx | stomach, B cell NHL, tx w chemo |
| is upper or lower GI bldg more common in HIV | lower |
| MC 2 causes upper GI bleeding in HIV | Kaposi, lymphoma |
| MC 3 causes lower GI bleeding hiV | CMV, bac, HSV |
| how commonly does HepC become chronic | 60% |
| how often does cirrhosis develop in hep C over how long; what can help prevent that | 15% over 20yrs; IFN |
| how often HCC in HepC | 1-5% |
| tx for brown recluse spider bite | dapsone |
| 3 MC organisms septic joint | Gono, Staph, H Flu |
| empiric tx septic joint until cx | Cephalo and vanc until cx |
| organisms in DM foot infxns | mixed: staph, strep, GNR, anaerobe |
| tx DM foot infxn | Unasyn, Zosyn |
| organism in cat/dog bite, tx | Pasteurella multocida, augmentin |
| organism in human bite, tx | Eikenella, augmentin |
| bug for impetigo, erysipelas, cellulitis, folliculits | Staph, strep |
| bug in furuncle, tx | Staph Epi or Staph Aureus, drain and Abx |
| 2 MC bug in peritoneal dialysis cath infxn | Staph Epi or Aureus, can also be fungal which is hard to tx |
| tx peritoneal dialysis cath infxn | intraperitoneal vanc and gen |
Created by:
ehstephns
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